Bacterial endocarditis

traction

1. BACTERIAL
ENDOCARDITIS
By group 6

2. Definition
Endocarditis, inflammation of the endocardium
can involve any of the endothilial lining of the
heart. The valves usually are affected.
Usually infection in mature, characterized by
colonization or invasion of the endocardium
and heart valves by a pathogen.
Inflamasi pada endokardium dan injap-injap
jantung. Kebanyakan seringkali adalah akibat
demam reumatik atau jangkitan bakteria. Ciri-
ciri utama termasuk demam, deruan jantung
yang menukar, kegagalan jantung dan
embolisme.

3. continue
There are two bacterial endocarditis:
Sub acute bacterial endocarditis
-develop more slowly and usually occurs
in people with pervious heart valve
damage.
Acute bacterial endocarditis
-has on abrupt on set and typically
affects people ith no pervious history of
heart problems.

10. Etiology
Previous heart damage.
Intravenous drug.
Invasive catheters (e.g. a central venous
catheter, heomodynamic monitoring, or an
indwelling urinary catheters)
Prosthetic valve endocarditis (PVE).
May occurs in clients with a mechanical or
tissue vale replacement.
Develop in the early post operative period or
late.
Usually affects males over the age.

11. Manifestation
Chills and fever
General malaise
Cough
Dyspnea
Anorexia
Abdominal pain
Fatigue
Heart murmur
Petechiae, splinter hemorrhages in nail bed.
Splenomegaly
Tachycardia-low CO
Localised headache
Altered mental status.

12. DIAGNOSTIC TEST:
Blood cultures –x 3
-For positive for bacteria or other pathogens.
Echocardiography
-to visualize vegetations can be diagnostic for
infective endocarditic.
Serologic immune testing for circulating
antigen to typical infective organisms may be
done.
-CBC,ESR,SERUM CREATIRINE
-CHEST X-RAY
-ELECTROCARDIOGRAM.

13. MEDICATION
Antibiotics commonly prescribed for clients (depends
on blood culture [4-6 weeks] RX).
Streptococcal and enterococcal infection are treated
with combination of penicillin and gentamycin.
Staphylococcal infection are treated with nafcillin or
oxacillin and gentamicin.
Intravenous drug therapy is continued for 2 to 8
weeks.
-depending on the infecting organisms, the drugs used
and the result of repeat blood cultures.
The clients with PVE requires extended treatment
using vancomycin, rifampin and gentamicin.
Dental surgical
Surgical-valve replacement.
Supplement nutrition.

14. COMPLICATION
Embolization of vegetation fragments may
affect lung, brain, kidneys and the skin and
mucous membranes with resulting organ
infarctions.
Ineffective endocarditic include heart
failure, abscess and aneurysm due to
infiltration of the arterial wall by organisms.
Heart failure due to valvular insufficiency.
Uncontrolled infection.
Embolic episodes-ischemic/ necrosis of
extremities/ organ.

15. NURSING ASSESSMENT
Identify patient at risk-heart murmur (heart
disease). Ineffective endocarditis
Healthy history:
-complaints of persistent flu like symptoms:
-Fatigue, shortness of breath and activity intolerance,
history of recent dental work or other invasive
procedure known heart disorder recent intravenous
drug use.
Physical examination:
-vital sign including apical pulse and heart sounds, rate
and ease of respiration, lung sounds, skin color,
temperature and presence of petechiae or splinter
hemorrhage.
Diagnostic test:
-WBC and differential, ESR, blood culture and
sensitivity results, echocardiogram reports.

16. NURSING DIAGNOSIS &
INTERVENTION
Risk for imbalanced body temperature
related to fever.
-Record temperature every 2 to 4 hours.
-Obtain blood culture as ordered, before
initial antibiotic dose.
-Provide anti-inflammatory or antipyretic
agents as prescribed.
-Administer antibiotic as ordered; obtain peak
though drug level as indicated.

17. continue
Risk for ineffective tissue perfusion related to
embolization or vegetative lesion due to left heart
infarction
-Assess for document and report manifestation of
described organ system perfusion.
-Neurologic; level consciousness, numbness, tingling,
inextremities, hemiplegia visual disturbance and stroke.
-Pulmonary dyspnea, haemoptysis, shortness of breath,
diminished breath sound, restlessness, sudden chest or
shoulder pain.
-Cardiovascular; chest pain radiating to jaw or arms,
tachycardia, anxiety, tachypnea, hypotension.
Assess and document skin color and temperature,
quality of peripheral pulse and capillary refill.

18. continue
Ineffective health maintenance related to deficit
of knowledge.
Demonstrate intravenous catheter site care and
intermittent antibiotic administration if the client and
family ill manage therapy. Have the client or
significant other redemonstrate appropriate
techniques.
Explain the actions, doses, administration and desired
and adverse effects of prescribed drugs.
Teach about the function of heart valves and the
effects of endocarditis,and explain the risk for its
recurrence.
Describe the manifestations of heart failure to be
reported to the physician.
Encourage good dental hygiene and mouth care and
require dental checkups. Teach how to prevent
bleeding from the gums and avoid developing mouth
ulcers. Flow water devices.

19. ANY
QUESTION
?

21. THANK YOU FOR PAY ATTENTION
•BY GROUP 6